Despite their names of 'eating' disorders, these illnesses go far beyond than disordered eating. According to the DSM IV- TR (Diagnostic and Statistical Manual of Mental Disorders, version IV) and with the help of Wikipedia, these conditions can be characterized by the following:
1) Anorexia Nervosa (AN): the diagnostic criteria for AN includes intense fear of gaining weight, a refusal to maintain body weight above 85% of the expected weight for a given age and height, and three consecutive missed periods; and either refusal to admit the seriousness of the weight loss, or undue influence of shape or weight on one's self image, or a disturbed experience in one's shape or weight. There are two types: the binge-eating/purging type is characterized by overeating or purging, while the restricting type is not.As mentioned already above, these illnesses are among the most complex and difficult to treat. Not only do clinicians have to address the biological issues--such as the physical consequences of altered heart rhythms--but the psychological (i.e. OCD, depression, suicidal ideation) and the social (i.e. parents separating, strained family relations, peer pressure) issues as well. For these reasons, patients with eating disorders are managed by 'multidisciplinary teams' consisting of the medical doctor, psychiatrist, nurses, psychologist, family therapist, dietitian, physiotherapist, and social worker.
2) Bulimia Nervosa (BN): includes repetitive episodes of binge eating (a discrete episode of overeating during which the individual feels out of control of consumption) compensated for by excessive or inappropriate measures taken to avoid gaining weight. The diagnosis is made only when the behavior is not a part of the symptom complex of anorexia nervosa and when the behavior reflects an overemphasis on physical mass or appearance. There are two sub-types of bulimia nervosa:
3) Eating Disorder Not Otherwise Specified (EDNOS): this category is frequently used to describe people who meet some, but not all, of the diagnostic criteria for AN or BN. For example, a person who shows almost all of the symptoms of anorexia nervosa, but who still has a normal menstrual cycle and/or body mass index, can be diagnosed with EDNOS. Or someone that restricts and shows most of the symptoms of anorexia but has occasional episodes of binging without purging. A sufferer may experience episodes of binging and purging, but may not do so frequently enough to warrant a diagnosis of bulimia nervosa.
- Purging type bulimics self-induce vomiting (usually by triggering the gag reflex or ingesting emetics such as syrup of ipecac) to rapidly remove food from the body before it can be digested, or use laxatives, diuretics, or enemas.
- Non-purging type bulimics (approximately 6%–8% of cases) exercise or fast excessively after a binge to offset the caloric intake after eating. Purging-type bulimics may also exercise or fast, but as a secondary form of weight control.
To someone unfamiliar with eating disorders, dealing with such patients can be quite overwhelming. In the hospital, patients' food intakes are monitored to the extreme: a dietitian sits and calculates each patients' caloric requirements and then subsequently devises a meal plan; nurses supervise mealtimes, ensuring that patients do not hide bits of food in their clothing, nor throw their food away over their shoulders or in the rubbish bins. Then, patients are confined to a small area after meals for at least a half hour each time, so that they can be monitored for compensatory behaviours such as purging their food or vigorously exercising to burn what they have just eaten. Still, no matter what great lengths our staff takes to ensure that these patients have sufficient caloric intakes that their body needs, the patients are very clever and always seem to be a step ahead of the clinicians. What's more is that when a patient is observed to be failing to take adequate amounts of food in, they are supplemented with food boluses fed through a nasogastric tube (one that connects from their nose and into their stomachs).
On observing these patients, one can also see how distraught these patients can be when it comes to meal times. Some of these patients just physically can't seem to bring themselves to eat; some will just sit there and cry whenever food is placed in front of them unless they are forced and encouraged to eat by the nursing staff. Moreover, it's hard not to feel frustrated at how these patients can't simply put foods in their mouths--this is because in their minds, their eating disorders are condemning and bashing them for the act of eating they are about to partake in. To put simply, it's as if the eating disorder is dictating patients what they should or should not do: they should pass up on eating, they should take any means to eliminate whatever food reaches their systems, and they should exercise self-discipline in order to satisfy the 'voices' in their heads. Now this is not to say that such patients can hear voices in their heads, much like patients with schizophrenia do, but it can be likened as such.
Given my own struggles with an eating disorder in the past, I find myself naturally drawn to help patients affected by them. In September 2007, my GP diagnosed me as having BN. By that time, I was obsessively exercising daily (sometimes even twice daily), binging then purging almost once daily, and severely restricting my food intake. I remember keeping a food diary, in which I would successively track every single morsel of food that went into my mouth. I would also spend at least an hour every day at the gym, pushing myself even on days when I felt low in energy. I would beat myself up if ever I missed a day and would push myself doubly hard the day after. I was terrified of being left alone at home because that was when I would do most of my binges and purges. Even after dinners out and family parties, I would find myself in front of the toilet bowl shortly after. I always carried a toothbrush with me, which I used to make myself gag and then throw up. I would beat myself up harshly on days when my body just won't seem to let me throw up what I had just eaten. At times, I even took to laxatives to get rid of any foods I had eaten that would possibly lead to weight gain, such as ice cream, chocolates, and desserts.
For a while, the above behaviors kept me well below the average weight for my age and height. I even used to weigh myself daily to keep track of whether or not my efforts were successful. I would cringe whenever I gained even just one pound (which for some, could just be water weight). Still, I persisted with these behaviors and secretly marvelled at how disciplined and dedicated I found myself to be. Most importantly, my weight and food intake were the only things I had control over during that period of my life. While everything else in my life was chaotic at the time, I felt relieved that I could control these aspects of my life.
And this is the very thing that lies central to a lot of the eating disorders--the sense of having control. All of the patients struggling with eating disorders under our service have consistently said that having control over their weights and food intake is what drives their disordered eating behaviors. They are the only two things in their lives that they are happy with, and are not willing to let go easily.
Luckily for me, my eating disorder had not taken hold of many years of my life. Some people, unfortunately, struggle with one for years on end (sometimes even decades). By June 2010, I had gotten over mine. Sometime within those three years, I felt that my eating disorder had suddenly stopped working for me--it no longer kept me underweight. In fact, I had actually started to fall on the higher end of the normal weight range for me, due to all the binging I was still doing, but the lack of compensatory behaviour I would do subsequently (i.e. the purging, excessive exercising, and use of laxatives). I got to the point in which I felt so disgusted at what I was doing and the way in which I was harming my body. I was at such a low point in myself that I was not even certain I could get out of. Not to mention, I felt like a hypocrite entertaining this disorder while studying Medicine. If I expected to help people suffering from similar conditions and if I were to counsel patients on healthy eating and exercise in my future practice, I couldn't go on with what I was doing. Enough was enough, and I knew that I had to find the strength within to overcome the 'Monster' (this was the name I had given my eating disorder, because of the immense power it had over me).
Looking back, I feel proud of having beaten this Monster of mine. I didn't think I could do it during the time that I struggled with it, and it was certainly a difficult point to achieve. After experiencing all this, I resolved to help others with similar struggles in the future.
Fast forward to about a year and a half later: this might sound really sick, but there are times in that year and a half that followed when I really miss having an eating disorder. (Don't worry, I'm not considering entertaining the Monster again). But you see, that Monster had given me the power of control, which I really miss having. Moreover, that Monster gave me a purpose--to exercise self-discipline and to control my weight and food intake. In a strange way, the Monster also kept me 'company', because it continuously dictated my every move. Especially after having moved to Australia, a land so far away from home and without having the supports of family and friends nearby, plus constantly feeling homesick, having the Monster around kept me from feeling too lonely.
Today, not a week passes by in which I do not get tempted to binge and purge. I still hold the same struggles with my weight and food intake that I had during those years of living with the Monster. Truthfully speaking, I don't think I can really get over the emotional baggage that accompanied the eating disorder (or at least not any time soon). All I can do now is remind myself of how far I've come and how I don't want to end up in the same low point in life where I once was.
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